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Friends Life Individual Protection

Critical Illness Cover and Critical Illness with Life CoverMembership handbook

FLIP/4564/May14

Membership handbook

Contents Welcome 3

General definitions 5

Critical illness definitions 9

Your membership 19

Additional options 22

What you are covered for 30

What you are not covered for 39

Changes to your membership 42

Premium options 48

How to make a claim 51

Your right to cancellation 55

General information 57

Getting in touch 60

Welcome

| 3

Welcome

Thank you for choosing Friends Life Individual Protection

Thank you for choosing critical illness cover

or critical illness with life cover from

Friends Life Individual Protection.

Friends Life Individual Protection products

are provided by Friends Life and Pensions

Limited, part of the Friends Life group.

With this membership we aim to provide you

and your dependants with protection should

serious illness or incapacity affect the

member’s ability to work and cause you

financial hardship, and help secure your

dependants’ financial future if a member is

to die.

The membership has been designed to offer

you the flexibility to provide you with the right

level of financial health protection to match

your circumstances.

Friends Life flexible financial protection is the

umbrella plan which provides cover through a

series of separate memberships for different

types and levels of cover.

Your registration certificate will show which

type of membership you have. Each

membership will have a separate handbook.

This handbook explains what is covered by

Friends Life Individual Protection Critical

Illness and Friends Life Individual Protection

Critical Illness with Life Cover and what to do

if you need to make a claim.

Using the membership handbook

The terms and conditions of this membership

handbook are the terms and conditions on

which we intend to rely. For your own benefit

and protection, you should read the terms

and conditions carefully. If you do not

understand any point please ask us for further

information.

Where the words ‘we’, ‘us’ or ‘our’ are used,

this refers to Friends Life and Pensions

Limited. The words ‘you’ or ‘your’ refer to the

person, or people, who are entitled to receive

the benefits of the membership. Where we

refer to the member(s), this refers to the

person, or people, covered under the same

membership. The terms you and member may

refer to the same people or different people.

Words printed in bold type in this handbook

are defined terms. Defined terms have a

specific meaning explained in the definition

section below or later on in the terms of this

handbook.

Welcome

Where we refer to you or to the member and

this refers to two people, we mean both

people jointly unless we say otherwise. For

example, where we say we will pay the

benefit to you, we mean both schemeholders

jointly, we will not pay the benefit twice.

Fairness of Terms(a) In making decisions and exercising

discretions given to us under the terms and

conditions of this membership handbook,

Friends Life will act reasonably and with

proper regard to the need to treat you and

our other customers fairly.

(b) The terms and conditions in your

membership handbook will only apply

provided that they are not held by a relevant

court or viewed by the Financial Conduct

Authority or by us to be unfair contract terms.

If a term is unfair it will, as far as possible, still

apply but without any part of it which causes

it to be unfair.

4 |

General definitions

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6 |

General definitions

General definitionsPlease refer to the definition explanations

below for further information on their

meanings.

Average Weekly Earnings

The measure used by the Office of National

Statistics which has replaced the average

earnings index. This measure is an indicator

of short-term earnings growth and provides

a monthly estimate of the level of average

weekly earnings per employee. Alternatively,

if this measure is not published during any

period of your membership the ‘average

weekly earnings measure’ will be any

substituted index or index of figures

published by that Office.

Benefit

The critical event benefit shown on your

registration certificate excluding the

terminal illness benefit. However, where

benefit is used in this handbook as being of

general application to all benefits covered by

this handbook, it shall be read so as to read

‘the benefit or the terminal illness benefit

as appropriate’.

Friends Life Individual Protection approved hospital

A centre of treatment which is registered, or

recognised under the local country’s laws, as

existing primarily for:

• carrying out major surgical operations; or

• providing treatment which only

consultants can provide

and which has been approved by Friends Life

Individual Protection.

Child / children

Any natural child or adopted child of you or

your spouse, partner or civil partner or any

child for which either you or your spouse,

partner or civil partner are the legal guardian.

Childcover benefit

The childcover benefit as defined in the ‘What

you are covered for’ section in this handbook.

Child funeral benefit

The child funeral benefit as defined in the

‘What you are covered for’ section in this

handbook.

Commencement date

The date your membership starts, as shown

on your registration certificate.

Consultant

A surgeon, anaesthetist or physician who:

• is legally qualified to practice medicine or

surgery following attendance at a

recognised medical school; and

• is recognised by the relevant authorities in

the country in which the treatment takes

place as having specialised qualification in

the field of, or expertise in, the treatment

of the disease or illness being treated.

By recognised medical school we mean a

medical school which is listed in the World

Directory of Medical Schools, as published

from time to time by the World Health

Organisation.

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General definitions

Critical illness(es)

Any of the illnesses and operations as defined

in the ‘Critical illness definitions’ section in this

handbook relate to any illness or operation

separately, not all of them together.

Endorsement(s)

Change(s) that you require and we agree to

be made to your membership after it

commences which are recorded in the

endorsement section of your registration

certificate.

Fracture

The fractures defined in ‘Black’s Medical

Dictionary’ (39th edition), comminuted,

complicated, compound, depressed,

greenstick, pathological and simple. The

fracture definition does not include any other

type of fracture.

Full time employment

Working a minimum of 35 hours a week.

Handbook

This handbook setting out the general terms

and conditions of your membership.

Irreversible

Cannot be reasonably improved upon by

medical treatment and/or surgical

procedures used by the NHS in the UK at the

time of the claim.

Member

The person (or people) named as a member in

your registration certificate. This is the

person (or people) for whom cover is provided.

Membership

The agreement between you and us to

provide the benefit on the terms set out in

the handbook and the documents referred

to in the section ‘Your membership’.

Mental impairment

Mental disorder causing incapacity which has

failed to respond to a minimum of two years

optimal treatment by a consultant

psychiatrist and requires the need for

continuous psychotropic medication,

supervision and care from a consultant and

results in severe dysfunctioning and the

prognosis is considered poor or worse.

NHS

National Health Service.

Occupation

A trade, profession or type of work

undertaken for profit or pay. It is not a

specific job with any particular employer and

is independent of location and availability.

Permanent

Expected to last throughout the life of the

person covered, irrespective of when the

membership ends or the member expects

to retire.

Permanent neurological deficit with persisting clinical symptoms

Symptoms of dysfunction in the nervous

system that are present on clinical

examination and expected to last throughout

the member’s life.

Symptoms that are covered include

numbness, hyperaesthesia (increased

sensitivity), paralysis, localised weakness,

dysarthria (difficulty with speech), aphasia

(inability to speak), dysphagia (difficulty in

swallowing), visual impairment, difficulty in

walking, lack of coordination, tremor, seizures,

lethargy, dementia, delirium and coma.

The following are not covered:

• an abnormality seen on brain or other

scans without definite related clinical

symptoms

• neurological signs occurring without

symptomatic abnormality, eg. brisk

reflexes without other symptoms

• symptoms of psychological or psychiatric

origin.

Registration certificate

The most recent registration certificate, we

issue to you.

Renewal date

If your registration certificate states that

your ‘Type of Cover’ is ‘Renewable Term (five

years)’, the renewal date will be the fifth

anniversary of the commencement date and

the end date of every following five year period.

If your registration certificate says the ‘Type

of Cover’ you have is ‘Renewable Term (ten

years)’, the renewal date will be the tenth

anniversary of the commencement date and

the end date of every following ten year period.

Retail Price Index

The general index of retail prices published by

the Office for National Statistics. Alternatively,

if that index is not published during any period

of your membership, the ‘retail price index’

will be any substituted index or index of

figures published by that Office.

Special condition

Any condition we set to limit your

entitlement under your membership, as

shown in the ‘Special Conditions’ section of

your registration certificate.

Suited occupation

Any work you could do for profit or pay

taking into account your employment history,

knowledge, transferable skills, training,

education and experience, and is irrespective

of location and availability.

Terminal illness benefit

The equivalent benefit in value to the benefit

but only relating to a member being

diagnosed with a terminal illness under a

Critical Illness with Life Cover membership.

UK

England, Northern Ireland, Scotland and Wales.

We / us / our

Refers to Friends Life and Pensions Limited.

You / your

Refers to the person (or people) named as

the schemeholder on your registration

certificate or any person (or people) to

whom your membership is validly assigned.

This is the person (or people) who hold the

membership.

8 |

General definitions

Critical illness definitions

| 9


Alzheimer’s disease

A definite diagnosis of Alzheimer’s disease by

a consultant neurologist, psychiatrist or

geriatrician. There must be permanent

clinical loss of the ability to do all of the

following:

• remember

• reason; and

• perceive, understand, express and give

effect to ideas.


• other types of dementia.

Aorta graft surgery

The undergoing of surgery to the aorta with

excision and surgical replacement of a

portion of the affected aorta with a graft. The

term aorta includes the thoracic and

abdominal aorta but not its branches.


• any other surgical procedure, for example,

the insertion of stents or endovascular

repair.

Aplastic anaemia

Confirmation by a consultant haemotologist

of a definite diagnosis of complete bone

marrow failure which results in anaemia,

neutropenia and thrombocytopenia and

requires as a minimum, one of the following

treatments:

• blood transfusion

• bone-marrow transplantation

• immunosuppressive agents

• marrow stimulating agents.

All other forms of anaemia are specifically

excluded.

Bacterial meningitis

Bacterial meningitis causing inflammation of

the membranes of the brain or spinal cord

resulting in permanent neurological deficit

with persisting clinical symptoms. The

diagnosis must be confirmed by a consultant

neurologist.


• all other forms of meningitis, not

mentioned above, including viral

meningitis.

Benign brain tumour

A non-malignant tumour or cyst originating in

the brain, cranial nerves or meninges within

the skull, resulting in any of the following:

• permanent neurological deficit with persisting clinical symptoms; or

• undergoing invasive surgery to remove

part or all of the tumour; or

• undergoing either stereotactic

radiosurgery or chemotherapy treatment

to destroy tumour cells.


• tumours in the pituitary gland

• tumours originating from bone tissue

• angiomas and cholesteatoma.

10 |


Benign spinal cord tumour

A non-malignant tumour in the spinal canal,

involving the meninges or the spinal cord.

This tumour must be interfering with the

function of the spinal cord which results in

permanent neurological deficit with

persisting clinical symptoms. The diagnosis

must be made by a relevant consultant and

must be supported by CT, MRI or

histopathological evidence.

The following are not covered: cysts,

granulomas, malformations in the arteries or

veins of the spinal cord, haematomas,

abscesses, disc protrusions and osteophytes.

Blindness

Permanent and irreversible loss of sight to

the extent that even when tested with the

use of visual aids, vision is measured at 6/60

or worse in the better eye using a Snellen eye

chart, or visual field is reduced to 20 degrees

or less of an arc, as certified by an

ophthalmologist.

Cancer

Any malignant tumour positively diagnosed

with histological confirmation and

characterised by the uncontrolled growth of

malignant cells and invasion of tissue.

The term malignant tumour includes

leukaemia, lymphoma and sarcoma except

cutaneous lymphoma (lymphoma confined to

the skin).


• all cancers which are histologically

classified as any of the following:

– pre-malignant

– non-invasive

– cancer in situ

– having either borderline malignancy; or

– having low malignant potential

• all tumours of the prostate unless

histologically classified as having a

Gleason score greater than six or having

progressed to at least clinical TNM

classification T2N0M0

• chronic lymphocytic leukaemia unless

histologically classified as having

progressed to at least Binet Stage A

• any skin cancer (including cutaneous

lymphoma) other than:

– malignant melanoma that has been

histologically classified as having

caused invasion beyond the epidermis

(outer layer of skin); or

– the occurrence of a malignant basal

cell carcinoma or malignant squamous

cell carcinoma positively diagnosed

with histological confirmation and

characterised by the uncontrolled

growth of malignant cells and invasion

of tissue. To satisfy the definition of

skin cancer in this bullet point, the skin

cancer must have invaded and spread

to lymph nodes or metastasised to

distant organs.

| 11


Cardiac arrest

Sudden loss of heart function with

interruption of blood circulation around the

body resulting in unconsciousness and

resulting in either of the following devices

being surgically implanted:

• Implantable Cardioverter-Defibrillator

(ICD); or

• Cardiac Resynchronization Therapy with

Defibrillator (CRT-D).

Cardiomyopathy

The unequivocal diagnosis by a consultant

cardiologist of cardiomyopathy resulting in

one or more of the following:

• impaired ventricular function and marked

limitation of physical activity where the

member is unable to progress beyond

stage two of a treadmill exercise test using the standard Bruce protocol; or is

• classified as Stage III under the New York

Heart Association (NYHA) Functional

Classification.

For the purpose of this definition NYHA

Stage III is classified as a marked limitation in

activity due to symptoms even during less

than ordinary activity. The patient is only

comfortable at rest.


• all other forms, other than those specified

above, of heart disease, heart

enlargement and myocarditis are

specifically excluded.

Chronic rheumatoid arthritis

A definite diagnosis by a consultant

rheumatologist of chronic rheumatoid

arthritis as evidenced by widespread joint

destruction with major clinical deformity.

In addition the member must permanently

satisfy three of the four following criteria:

Bending - The inability to bend or kneel to

pick up something from the floor and stand

up again and the inability to get into and out

of a standard saloon car.

Dexterity - The inability to use hands and

fingers to pick up and manipulate small

objects such as cutlery, including being

unable to write using a pen or pencil.

Lifting - The inability to lift, carry or otherwise

move everyday objects by hand. Everyday

objects include a kettle of water, a bag of

shopping and an overnight bag or briefcase.

Mobility - The inability to walk a distance of

200 metres on flat ground, with or without

the aid of a walking stick and without having

to rest or experiencing severe discomfort.

Coma

A state of unconsciousness with no reaction

to external stimuli or internal needs which:

• requires the use of life support systems;

and

• results in permanent neurological deficit with persisting clinical symptoms.

12 |


| 13



• medically induced coma

• coma secondary to alcohol or drug abuse.

Coronary artery by-pass grafts

The undergoing of surgery requiring

thoracotomy (keyhole surgery or median

sternotomy) on the advice of a consultant

cardiologist to correct narrowing or blockage

of one or more coronary arteries with

by-pass grafts.

Creutzfeldt-Jakob disease

Confirmation by a consultant neurologist of a

definite diagnosis of Creutzfeldt-Jakob

disease resulting in permanent neurological

deficit with persisting clinical symptoms.

Crohn’s disease

A definite diagnosis by a consultant

gastroenterologist of Crohn’s disease.

There must have been two or more bowel

segment resections on separate occasions.

There must also be evidence of continued

inflammation with current symptoms.

Deafness

Permanent and irreversible loss of hearing

to the extent that loss is greater than 95

decibels across all frequencies in the better

ear using a pure tone audiogram.

Dementia

A definite diagnosis of dementia by a

consultant neurologist, psychiatrist or

geriatrician. There must be permanent

clinical loss of the ability to do all of the

following:

• remember

• reason; and

• perceive, understand, express and give

effect to ideas.

The following is not covered:

• Alzheimer’s disease.

Diabetes mellitus type 1

A definite diagnosis of diabetes mellitus type 1

with first diagnosis over age 40, with abrupt

onset requiring the permanent use of insulin

injections that must have continued for a

period of at least 12 months.


• gestational diabetes

• type 2 diabetes (including type 2 diabetes

treated with insulin)

• latent autoimmune diabetes of adulthood

We will not pay the benefit for type 1 insulin

dependent diabetes mellitus, as defined

above, if the diagnosis is made within the 12

months before the date on which your

membership will end and may not be

renewed.

Heart attack

Death of heart muscle, due to inadequate

blood supply, that has resulted in all of the

following evidence of acute myocardial

infarction:

• the characteristic rise of cardiac enzymes

or Troponins

• new characteristic electrocardiographic

changes or other positive findings on

diagnostic imaging tests.

The evidence must show a definite acute

myocardial infarction.


• other acute coronary syndromes

• angina without myocardial infarction.

Heart valve replacement or repair

The undergoing of surgery requiring

thoracotomy (keyhole surgery or median

sternotomy) on the advice of a consultant

cardiologist to replace or repair one or more

heart valves.

HIV infection

Infection by Human Immunodeficiency Virus

resulting from:

• a blood transfusion given as part of

medical treatment;

• a physical assault; or

• an incident occurring during the course of

performing normal duties of employment

from the eligible occupations listed below:

– ambulance workers

– chiropodists

– dental nurses

– dental surgeons

– district nurses

– fire brigade firefighters

– general practitioners

– hospital caterers

– hospital cleaners

– hospital doctors, surgeons and

consultants – hospital laboratory technicians

– hospital laundry workers

– hospital nurses

– hospital porters

– midwives

– nurses employed by general

practitioners

– occupational therapists

– paramedics

– physiotherapists

– podiatrists

– policemen and policewomen

– prison officers

– radiologists

– refuse collectors

– social workers

after the start of the policy and satisfying all

of the following:

• the incident must have been reported to

appropriate authorities and have been

investigated in accordance with the

established procedures

14 |


• where HIV infection is caught through a

physical assault or as a result of an

incident occurring during the course of

performing normal duties of employment,

the incident must be supported by a

negative HIV antibody test taken within

five days of the incident

• there must be a further HIV test within 12

months confirming the presence of HIV or

antibodies to the virus.


• HIV infection resulting from any other

means, including sexual activity or drug

misuse.

Kidney failure

Chronic and end stage failure of both kidneys

to function, as a result of which regular

dialysis is permanently required.

Liver failure

Chronic liver disease, being end stage liver

failure due to cirrhosis and resulting in all of

the following:

• permanent jaundice

• ascites

• encephalopathy.

Loss of hands or feet

Permanent physical severance of any

combination of one or more hands or feet at

or above the wrist or ankle joints.

Loss of independence

The total and permanent loss of the ability

to perform routinely at least three of the

specified six ‘activities of daily living’ without

the continual assistance of someone else,

even with the use of special devices or

equipment.

The following are activities of daily living:

Washing - this means being able to wash and

bathe unaided, including getting into and out

of the bath or shower.

Dressing - this means being able to put on,

take off, secure and unfasten all necessary

items of clothing.

Feeding - this means being able to eat

pre-prepared foods unaided.

Continence - this means being able to

control bowel or bladder functions, whether

with or without the use of protective

undergarments and surgical appliances.

Moving - this means being able to move from

one room to another on level surfaces.

Transferring - this means being able to get on

and off the toilet, in and out of bed and move

from a bed to an upright chair or wheelchair

and back again.

Loss of speech

Total permanent and irreversible loss of the

ability to speak as a result of physical injury

or disease.

| 15


Major organ transplant

The undergoing as a recipient from another

donor, or inclusion on an official UK waiting

list for any of the following:

• transplant of a bone marrow, or

• transplant of a complete heart, kidney,

liver, lung or pancreas, or

• transplant of a lobe of liver, or

• transplant of a lobe of lung.


• transplant of any other organs, parts of

organs or cells.

Motor neurone disease

A definite diagnosis of one of the following

motor neurone diseases by a consultant

neurologist:

– Amyotrophic lateral sclerosis (ALS)

– Primary lateral sclerosis (PLS)

– Progressive bulbar palsy (PBP)

– Progressive muscular atrophy (PMA).

There must also be permanent clinical

impairment of motor function.

Multiple sclerosis

A definite diagnosis of multiple sclerosis by a

consultant neurologist, that has resulted in

either of the following:

• clinical impairment of motor or sensory

function, which must have persisted for a

continuous period of at least three

months; or

• two or more attacks of impaired motor or

sensory function together with findings of

clinical objective evidence on Magnetic

Resonance Imaging (MRI).

All of the evidence must be consistent with

multiple sclerosis.

Open heart surgery

The undergoing of open heart surgery

requiring thoracotomy on the advice of a

consultant cardiologist.


• any percutaneous, transluminal or

investigative procedure.

Paralysis of limbs

Total and irreversible loss of muscle function

to the whole of any one limb.

Parkinson’s disease

A definite diagnosis of Parkinson’s disease by

a consultant neurologist.

There must be permanent clinical

impairment of motor function with associated

tremor or muscle rigidity.


• Parkinsonian syndromes/Parkinsonism

Progressive supranuclear palsy

Confirmation by a consultant neurologist of a

definite diagnosis of progressive

supranuclear palsy.

16 |


There must be permanent clinical

impairment of all of the following:

• motor function

• eye movement disorder; and

• postural instability.

Respiratory failure

Confirmation by a consultant physician of

severe lung disease which is evidenced by all

of the following:

• the need for continuous daily oxygen

therapy on a permanent basis;

• evidence that oxygen therapy has been

required for a minimum period of six

months;

• FEV1 being less than 40 percent of

normal; and

• vital capacity less than 50 percent of

normal.

Stroke

Death of brain tissue due to inadequate

blood supply or haemorrhage within the skull

resulting in either:

• permanent neurological deficit with persisting clinical symptoms;

or

• definite evidence of death of tissue or

haemorrhage on a brain scan; and

• neurological deficit with persistent clinical

symptoms lasting at least 24 hours.


• transient ischaemic attack

• death of tissue of the optic nerve or

retina/eye stroke.

Systemic lupus erythematosus (SLE)

A definite diagnosis of systemic lupus

erythematosus (SLE) by a consultant

rheumatologist resulting in:

• permanent impaired renal function

evidenced by a glomerular filtration rate

below 30 ml/min/1.73m2; and

• urinalysis showing proteinuria or

haematuria;

or

• permanent neurological deficit

evidenced by one of the following

persisting clinical symptoms - paralysis,

localised weakness, dysarthria (difficulty

with speech), dysphagia (difficulty in

swallowing), difficulty in walking or lack of

co-ordination.

For the purposes of this definition seizures,

headaches, fatigue, lethargy or any

symptoms of psychological or psychiatric

origin will not be accepted as evidence of

permanent neurological deficit.

| 17



18 |

Terminal illness

A definite diagnosis by the attending

consultant of an illness that satisfies both of

the following:

• the illness either has no known cure or has

progressed to the point where it cannot be

cured; and

• in the opinion of the attending consultant,

the illness is expected to lead to death

within 12 months.

Third degree burns

Burns that involve damage or destruction of

the skin to its full depth through to the

underlying tissue and covering at least 20

percent of the body’s surface area or 20

percent loss of surface area of the face which

for the purposes of this definition includes the

forehead and ears.

Traumatic brain injury

Death of brain tissue due to traumatic injury

resulting in permanent neurological deficit

with persisting clinical symptoms.

Ulcerative colitis

A definite diagnosis of ulcerative colitis which

is treated with total colectomy (removal of

entire large bowel).

A definite diagnosis of ulcerative colitis must be

confirmed by a consultant gastroenterologist.

Your membership critical illness cover or critical illness with life cover

| 19

Your membership - critical illness cover or critical illness with life coverYour membership is made up of the

following documents:

• your application for cover

This includes your initial application and

any further applications you make where

your membership is varied. It also

includes any declarations you made at

our request when you applied for cover.

• your registration certificate and any

endorsements

These set out the current details of your

membership. The ‘Special conditions’

section of your registration certificate

shows any special conditions we apply

to your membership.

Your registration certificate may also

refer to other memberships you have

under the Friends Life flexible financial

protection plan.

We explain how your registration certificate may change in the ‘General

information’ section.

• this handbook

This contains all the general terms and

conditions of your membership. It is

referred to as the ‘Friends Life Individual

Protection Critical Illness and Friends Life

Individual Protection Critical Illness with

Life Cover’ membership handbook,

reference number FLIP/4564/May14.

When your membership starts and ends

Your membership starts on the

commencement date and is subject to you

paying your first premium.

The date your membership ends depends

on the type of cover you have.

If your registration certificate shows that

the type of cover you have is ‘Renewable

term’ (either five years or ten years), your

membership will end on the earliest of the

following:

• any renewal date on which you do not

renew your membership or we end your

membership

• where the renewal term is five years the renewal date is before the member’s 65th birthday (or the eldest member if more than one)

• where the renewal term is ten years, the renewal date is before the member’s 70th birthday (or the eldest member if more than one)

• where you have a critical illness cover membership, the death of a member

20 |

Your membership

• the date we pay you the benefit

• 30 days after the premium due date, we will allow your membership to continue if you pay any outstanding amount within

the 30 day period after it became due.

If you do not have ‘Renewable term’ cover

your membership will end on the earliest of

the following:

• the ‘expiry date’ shown on your registration certificate

• where you have a critical illness cover membership, the death of a member

• the date we pay you the benefit

• 30 days after the premium due date

where you do not pay any amounts. We will allow your membership to continue if you pay any outstanding amounts within

the 30 day period after it became due.

Failure to disclose a fact, giving false

information or failing to tell us of a change in

your health or circumstances in relation to

any question in your application before cover

starts where done deliberately or recklessly

gives us the right to cancel from the start any

membership issued as a result and may

invalidate a future claim. However, where that

information was given carelessly, or the

failure to disclose relevant information was

careless, then we will amend the terms of

your membership to be consistent with

what the terms should have been based on

the correct information, unless we would not

have offered any terms for the membership

applied for, in which case we have the right

to cancel the membership from the start

and return any premiums.

Your membership will end regardless of

whether it was you or a member or both

who misled us.

You can end your membership by writing to

us providing 30 days notice to tell us at the

address stated in the ‘General information’

section.

| 21

Your membership

Additional options

22 |

| 23

Additional options

Additional optionsYour registration certificate will show

whether we have provided any of the

following additional options to you. If there is

more than one member, your registration

certificate will show to which member the

option applies or whether it applies to both.

The following are the full list of additional

options. These are only applicable if you

have selected and we have agreed to

provide the option:

• indexation options

• fracture cover option

• premium waiver option

• total permanent disability option

• reinstatement option.

Indexation options

For each of these options, on each

anniversary of the commencement date,

we will increase the benefit under your

membership. The amount the benefit

increases by will depend on the indexation

option applicable.

If we have agreed to provide this option,

your registration certificate will show

which indexation option you have of the

following:

• RPI (Retail Price Index)

• AWE (Average Weekly Earnings)

• five percent

• three percent.

The increases for each indexation option are

as follows:

RPI (Retail Price Index) option

On the anniversary of the commencement

date, we will increase the benefit in

proportion to the increase in the RPI during

the first 12 months of the 15 month period

immediately before the anniversary of the

commencement date.

The maximum increase on any anniversary

will be 10 percent of the benefit.

AWE (Average Weekly Earnings) option


date we will increase the benefit in

proportion to the increase in the AWE

measure over the first 12 months of the 17

month period immediately before that

anniversary of the commencement date.

Five percent option


date, we will increase the benefit by five

percent a year.

Three percent option


date, we will increase the benefit by three

percent a year.

24 |

Additional options

How does indexation affect your premiums?

You will have to pay an increased premium

for any increase in the benefit. Your premium

will increase at a higher rate than your

benefit as we will allow for member’s age

and remaining term at the time of the

increase in the benefit. For guaranteed and

reviewable premiums the increase will be

based on our premium rates at the

commencement date. For renewable

premiums, the increase will be based on our

premium rates applicable at the later of the

commencement date or at the last renewal.

When we write to tell you about the increase

in the benefit, we will tell you about the

increase in your premium.

Cancelling an increase

You can cancel the increase in the benefit

and your premium by writing to us within 30

days of the date of our letter telling you

about the increase. If you cancel any

increases we will cancel your indexation

option and no further increases will be made

(this will not affect previous increases).

Fracture cover option

If we have agreed to provide the fracture

cover option, your registration certificate

will show this option. If there is more than

one member we may have agreed to cover

one or both members and this will also show

on your registration certificate. If the

member suffers one of the fractures shown

in the table below, we will pay fracture cover

benefit to you. The amount of the fracture

cover benefit we will pay is shown in the

table below:

To make a claim for fracture cover benefit

you must:

• contact us to ask for a claim form; and

then

• fill in the claim form and return it to us.

You must make your claim as soon as

reasonably practicable.

Fracture cover benefitFracture

closed fracture of the skull

open fracture of the skull

fracture of the vertebra

fracture of the shoulder blade

fracture of the jaw

fracture of the sternum

fracture of the pelvis

fracture of the wrist

fracture of the hand

fracture of the upper leg

fracture of the knee

fracture of the lower leg

fracture of the arm

fracture of the cheekbone

fracture of the foot

fracture of the ankle

fracture of the ribs

fracture of the collar bone

£1,200

£2,100

£900

£900

£900

£900

£1,200

£900

£900

£2,100

£2,100

£1,200

£1,200

£900

£900

£1,200

£600

£600

| 25

Additional options

We will only pay the benefit to you for the

following fractures as defined in ‘Black’s

Medical Dictionary’ (39th edition);

comminuted, complicated, compound,

depressed, greenstick, pathological and

simple. We will not pay the benefit for any

other type of fracture.

Where more than one of the above fractures

occurs at any time, we will only pay fracture

cover benefit for one of the fractures. You

can decide which fracture you claim for.

We will not pay fracture cover benefit to you

if the fracture arises out of the same event

as that for which we have paid the benefit

to you.

We will only pay fracture cover benefit to

you for one fracture suffered during any 12

month period. The first 12 month period will

start on the commencement date and then

each subsequent 12 month period will begin

on each anniversary of the commencement

date.

We will not pay fracture cover benefit for a

fracture suffered by a child.

Total permanent disability option

This is only applicable if you have selected

and we have agreed to provide the total

permanent disability option, this will show on

your registration certificate. If there is more

than one member we may have agreed to

cover one or both members and this will also

show on your registration certificate. This

option ends when your membership ends.

With this option we will pay the benefit if the

member that the option applies to becomes

totally and permanently disabled as defined

in this handbook. Any disability must

continue for a minimum of six months before

we will consider whether it is a ‘total

permanent disability’ for the purpose of your

membership.

What is total permanent disability?

Your registration certificate will show

whether the definition of total permanent

disability for a particular member is ‘own’,

‘suited’ or ‘activities of daily work’. The

definitions are as follows:

‘Own’ definition

Loss of the physical or mental ability through

an illness or injury to the extent that the

member is unable to do the essential duties

of their own occupation ever again. The

essential duties are those that are normally

required for, and form a significant and

integral part of, the performance of the

member’s own occupation that cannot

reasonably be omitted or modified.

The relevant consultant must reasonably

expect that the disability will last throughout

life with no prospect of improvement,

irrespective of when the cover ends or the

member expects to retire.

‘Suited’ definition

Loss of the physical or mental ability through

an illness or injury to the extent that the

member is unable to do the essential duties

26 |

Additional options

of a suited occupation ever again. The

essential duties are those that are normally

required for, and form a significant and

integral part of, the performance of a suited

occupation that cannot reasonably be

omitted or modified.






‘Activities of daily work’ definition

Loss of the physical ability through an illness

or injury to do at least three of the six work

tasks listed below ever again.






The member must need the help or

supervision of another person and be unable

to perform the task on their own, even with

the use of special equipment routinely

available to help and having taken any

appropriate prescribed medication.

‘Activities of daily work’

The work tasks are:

Walking

The ability to walk more than 200 metres on

a level surface.

Climbing

The ability to climb up a flight of 12 stairs and

down again, using the handrail if needed.

Lifting

The ability to pick up an object weighing 2kg

at table height and hold for 60 seconds

before replacing the object on the table.

Bending

The ability to bend or kneel to touch the floor

and straighten up again.

Getting in and out of a car

The ability to get into a standard saloon car,

and out again.

Writing

The manual dexterity to write legibly using a

pen or pencil, or type using a desktop

personal computer keyboard.

Premium waiver option


and we have agreed to provide the premium

waiver option, this will show on your

registration certificate. If there is more than

one member we may have agreed to cover

one or both members and this will also show

on your registration certificate.

This option ends when your membership

ends.

If the member that the option relates to is in

an occupation and was on the

commencement date, we will waive your

premiums for the period the member is

unable to do their normal occupation, as a

| 27

Additional options

result of illness and injury, provided that the

member is not doing any other occupation.

If the member that the option relates to is

not in an occupation or was not on the

commencement date, we will waive your

premiums for the period that the member is,

as a result of illness or injury, unable to do at

least three of the daily activities listed below:

Daily activities

Shopping

Being able to get to and from the nearest

shops and carry a small bag of shopping.

Cooking

Being able to prepare and cook a basic meal.

Housework

Being able to carry out light housework such

as dusting, washing dishes and making beds.

Handling money

Being able to handle basic household

finances and recognise the value of money.

Taking medicine

Being able to take routine medication

prescribed by a recognised medical

practitioner.

Child minding

Being able to care for, feed, wash and dress a

child under the age of five.

We will waive your premiums until:

• the member can do their occupation; or

• the member starts any paid work; or

• the member becomes capable of doing

four or more of the daily activities shown

above (if the member was not in an

occupation); or

• your membership ends.

If, as a result of illness or injury, the member

becomes unable to do their occupation or

unable to do at least three of the daily

activities listed above, you must make a

claim to us to waive your premiums before

you are entitled to any waiver. To do this you

must:

• contact us to ask for a claim form; and

then

• fill in the claim form and return it to us.

You must give us any information or proof

we reasonably require to consider your claim

both at the time of your claim and at any

time when we are waiving your premiums.

If we accept your claim, we will not waive

your premiums until the end of the three

month period following either the date the

member became unable to do their

occupation or the date they became unable

to do at least three of the daily activities as

appropriate.

You must make your claim within six months

of the illness or injury arising or as soon as

reasonably practicable. If you do not, we

may not waive your premiums for the period

of delay in making your claim.

During any period where we waive your

premiums, you must notify us as soon as

practicable of the member:

• starting an occupation

• no longer being incapable of doing three

or more of the daily activities

• being capable of doing their occupation.

If you fail to do so, we may end your

membership.

Reinstatement option


and we have agreed to provide you with the

reinstatement option.

If we have provided the reinstatement option

and we pay the benefit to you in the event

of a member suffering or undergoing a

critical illness, you can take out a new

membership subject to all of the following:

• you tell us in writing that you want to take

out the new membership

• if the benefit was paid due to a member having cancer, the new membership can

only be taken out within five years of the

date we paid the benefit and you must

provide us with all of the following:

– the written confirmation of the doctors

who treated the member that the

member made a full recovery at least

one year prior to you applying to us for

the new membership; and

– evidence that the member has not

undergone any tests that show the

presence of cancer since the full

recovery from cancer was made; and

– evidence that the member has

attended all consultations and check

ups and undergone all tests

recommended by the medical

specialist for cancer

• if the benefit was paid due to a critical illness other than cancer, the new membership can only be taken out

between 12 and 24 months after the date

we paid the benefit

• the only critical illnesses to be covered

under the new membership are the

following (the illnesses and definitions of

these will be those we apply at the time

the new agreement is taken out):

– aorta graft surgery

– aplastic anaemia

– bacterial meningitis

– cancer

– cardiomyopathy

– heart attack

– HIV/AIDS

– kidney failure

– liver failure

– major organ transplant

– motor neurone disease

– multiple sclerosis

– Parkinson’s disease

– progressive supranuclear palsy

– stroke

– systemic lupus erythematosus

– third degree burns

28 |

Additional options

| 29

Additional options

• claims for the same event for which we paid benefit to you will be excluded from

the new membership

• we will only consider claims under the

new membership for events or illnesses

occurring or being diagnosed after the

commencement of your new membership

• the new membership will cover the same

member (or both if more than one) as

under this membership

• the new membership will not continue

beyond the date your membership would

have ended

• the membership must have been capable

of continuing for at least five years after

the date we receive the request for your new membership

• the amount of benefit provided will be the

lower of £100,000 or the benefit we paid

under your membership

• the member to be covered by the new membership (or eldest member if more

than one) is under 50 years of age

• life cover will only be provided under the

new membership where your original

membership is for critical illness with life

cover

• no additional options can be included in

the new membership

• no claim for terminal illness benefit will

be included in the new membership

• the terms and conditions of the new membership will be those we apply at the

time the new membership is taken out

• we accepted the initial application for

cover without increasing the premiums

above our standard rates at that time or

applying any special conditions to the membership.

The premiums you will have to pay for the

new membership will be based on our

premium rates and the member’s age on the

commencement date of the new

membership.

The reinstatement option is not available for

and will not include childcover benefit.

The reinstatement option can only be

effected once.

What you are covered for

30 |

| 31



Benefit

We will pay the benefit to you if, during the

period of your membership any of the

following happens:

• a member suffers or undergoes a critical illness; or

• a member becomes totally and

permanently disabled (if we have

provided the total permanent disability

option); or

• where you have a critical illness with life

cover membership, either of the following

happens;

– a member dies; or

– a member is diagnosed with a terminal

illness. The relevant benefit payable for

a terminal illness for a Critical Illness

with Life Cover membership will be

the terminal illness benefit.

Payment of the benefit is subject to:

• you complying with the requirements and

obligations set out in the ‘How to make a

claim’ section.

• your claim not being excluded by any of

the circumstances listed in the ‘What you are not covered for’ section.

We will only pay the benefit or the terminal

illness benefit once and not both under this

membership, on the first of the above events

to happen.

For any claim under the total permanent

disability option, we will only pay the benefit

after the disability has continued for six

months, subject to the additional terms of the

total permanent disability option set out in

the ‘Additional options’ section.

Carcinoma in situ of the cervix uteri – requiring hysterectomy

We will pay the lower of 12.5 percent of the

benefit and £12,500 if a member is

diagnosed with carcinoma in situ of the

cervix uteri (cervix) requiring treatment with

hysterectomy.

The hysterectomy must have been performed

on the advice of a consultant to treat

carcinoma in situ.

The following tumors are excluded:

• all grades of dysplasia;

• cervical squamous epithelial lesion (SIL);

and

• cervical intra-epithelial neoplasia (CIN),

unless carcinoma in situ is present.

The carcinoma in situ of the cervix uteri

requiring hysterectomy benefit is payable in

addition to the benefit you have under your

membership. We will only pay this benefit

once for each member regardless of the

number of memberships held.

Carcinoma in situ of the urinary bladder



diagnosed with carcinoma in situ of the

urinary bladder.

The diagnosis must be histologically

confirmed on a pathology report. This benefit

is payable only once. Non-invasive papillary

carcinoma, stage Ta bladder carcinoma and

all other forms of non-invasive carcinoma are

specifically excluded.

The carcinoma in situ of the urinary bladder

benefit is payable in addition to the benefit

you have under your membership. We will

only pay this benefit once for each member

regardless of the number of memberships

held.

Cerebral aneurysm - with surgical repair


benefit and £12,500 if a member undergoes

either of the following surgical procedures in

order to treat a cerebral aneurysm:

• surgical correction via craniotomy

(surgical opening of the skull); or

• endovascular treatment using coils or

other materials (embolisation).

The cerebral aneurysm benefit is payable in





Cerebral arteriovenous malformation - with surgical repair



either of the following surgical procedures in

order to treat a cerebral arteriovenous

malformation:

• surgical correction via craniotomy

(surgical opening of the skull); or

• endovascular treatment using coils or

other materials (embolisation).

The cerebral arteriovenous malformation

benefit is payable in addition to the benefit

you have under your membership. We will

only pay this benefit once for each member


held.

Coronary angioplasty

We will pay the lower of 25 percent of the


any of the following:

• balloon angioplasty

• atherectomy

• rotablation

• laser treatment, or

• insertion of stents.

The above operations must have been carried

out on the advice of a consultant cardiologist

to treat severe coronary artery disease in two

or more main coronary arteries. The above

operation must be to treat at least 70 percent

diameter narrowing. If an operative procedure

is only performed on one main coronary artery

there must be at least 70 percent diameter

narrowing in another main coronary artery.

For the purposes of this definition main

coronary arteries are described as one or

more of the following:

• right coronary artery

• left main stem

32 |


| 33


• left anterior descending

• circumflex.


• procedures to any branches of any of the

main coronary arteries.

The coronary angioplasty benefit is payable

in addition to the benefit you have under

your membership. We will only pay this

benefit once for each member regardless of

the number of memberships held.

Crohn’s disease – treated with surgical intestinal resection



diagnosed with Crohn’s disease and has

undergone surgical intestinal resection.

A definite diagnosis of Crohn’s disease must be

confirmed by a consultant gastroenterologist.

Crohn’s disease treated with surgical

intestinal resection benefit is payable in





We will not pay this benefit to you if we have

already paid the benefit to you for Crohn’s

disease - of specified severity, as defined in

the ‘Critical illness definitions’ section of this

handbook.

Ductal carcinoma in situ of the breast - with specified treatment



diagnosed with ductal carcinoma in situ

(DCIS), histologically confirmed, and as a

result requires total mastectomy,

segmentectomy or lumpectomy.

DCIS of the breast treated by other methods

and lobular carcinoma in situ are specifically

excluded.

DCIS of the breast benefit is payable in





Low-grade prostate cancer



diagnosed with a tumour of the prostate

histologically classified as having a Gleason

score between 2 and 6 inclusive provided:

• the tumour has progressed to at least

clinical TNM classification T1N0M0; and

• treatment included the complete removal

of the prostate or external beam or

interstitial implant radiotherapy.

For clarity, cases treated with cryotherapy,

other less radical treatment (eg. transurethral

resection of the prostate), experimental

treatments or hormone therapy are not

included.

34 |


The low-grade prostate cancer benefit is

payable in addition to the benefit you have

under your membership. We will only pay

this benefit once for each member


held.

Non-malignant pituitary adenoma - with specified treatment



diagnosed with a non-malignant pituitary

tumour requiring radiotherapy or surgical

removal.

Non-malignant tumours of the pituitary gland

treated by other methods are specifically

excluded.

This benefit is payable in addition to the

benefit you have under your membership.

We will only pay this benefit once for each

member regardless of the number of

memberships held.

Removal of one or more lobe(s) of the lung – for disease and trauma



the removal of one or more lobes of the lung

due to underlying disease or trauma. The

surgery must be carried out on the advice of

a consultant physician. The removal of one or

more lobe(s) of the lung – for disease and

trauma benefit is payable in addition to the

benefit you have under your membership.

We will only pay this benefit once for each

member regardless of the number of

memberships held.

Significant visual loss


benefit and £25,000 if a member suffers

permanent and irreversible loss of sight to

the extent that even when tested with the

use of visual aids, vision is measured at 6/24

or worse in the better eye using a Snellen eye

chart, or visual field is reduced to 45 degrees

or less of an arc, as certified by an

ophthalmologist.

Significant visual loss benefit is payable in





We will not pay this benefit to you if we have

already paid the benefit to you for blindness

as defined in the ‘Critical illness definitions’

section of the membership handbook.

Acceleration payment benefit for specified surgical treatments

We will make an advance payment if a

member is on the NHS waiting list for one of

the following types of surgical treatments, as

defined in ‘Critical illness definitions’ section

of this handbook:

• aorta graft surgery

• coronary artery by-pass grafts

• heart valve replacement or repair

• open heart surgery.

| 35



benefit and £25,000.

To be eligible for this acceleration payment

benefit, the member must be on the relevant

NHS waiting list for the hospital where it is

proposed the surgical treatment is to take

place.

When an advance payment is made under

this acceleration payment benefit for

specified surgical treatments, your benefit

will be reduced by the amount of the

accelerated payment we make to you.

This accelerated payment is also applicable

for eligible children.

We will always pay the benefit in respect of

carcinoma in situ of the cervix requiring

hysterectomy; carcinoma in situ of the urinary

bladder; Crohn’s disease treated with surgical

intestinal resection; ductal carcinoma in situ of

the breast - with specified treatment;

low-grade prostate cancer; coronary

angioplasty; cerebral aneurysm - with surgical

repair; cerebral arteriovenous malformation

- with surgical repair; non-malignant pituitary

adenoma - with specified treatment; removal

of one or more lobe(s) of the lung – for disease

and trauma; significant visual loss or surgical

treatments, as a lump sum, with the lump sum

calculated by reference to the benefit.

Childcover benefit

We will pay childcover benefit to you, if

during the period of the agreement, a child

suffers or undergoes a critical illness, suffers

cerebral palsy, cystic fibrosis, hydrocephalus,

muscular dystrophy or spina bifida as defined

below, requires intensive care as defined

below or suffers or undergoes one of the

conditions as defined in the ‘What you are

covered for’ section of this handbook,

subject to you complying with the

requirements and obligations set out in the

‘How to make a claim’ section, unless your

claim is excluded by any of the

circumstances listed in the ‘What you are not

covered for’ section.

Children’s intensive care benefit – requiring mechanical ventilation for 7 days

We will pay childcover benefit to you, if

during the period of the agreement, a child

due to sickness or injury is requiring

continuous mechanical ventilation by means

of tracheal intubation for 7 consecutive days

(24 hours per day) unless it is as a result of

the child being born prematurely (before 37

weeks). Please refer to ‘What you are not

covered for’ section for exclusions and

limitations of the cover.

Cerebral palsy

We will pay childcover benefit to you if the

child receives a definite diagnosis of cerebral

palsy made by an attending consultant.

Cystic fibrosis


child receives a definite diagnosis of cystic

fibrosis made by an attending consultant.

Hydrocephalus - treated with the insertion of a shunt


child suffers hydrocephalus if the

hydrocephalus is treated with an insertion of

a shunt.

Muscular dystrophy


child receives a definite diagnosis of

muscular dystrophy made by a consultant

neurologist.

Spina bifida


child receives a definite diagnosis of spina

bifida myelomeningocele or rachischisis by a

paediatrician.


• spina bifida occulta

• spina bifida with meningocele.

Childcover benefit is the lower of 50

percent of the benefit and £25,000 unless;

• the child suffers:

– coronary angioplasty;

– low-grade prostate cancer; or

– significant visual loss;

then the childcover benefit will be the

lower of 25 percent of the benefit and

£25,000, or;

• the child suffers:

– carcinoma in situ of the cervix requiring

hysterectomy;

– carcinoma in situ of the urinary

bladder;

– cerebral aneurysm - with surgical

repair;

– cerebral arteriovenous malformation

- with surgical repair;

– Crohn’s disease treated with surgical

intestinal resection;

– ductal carcinoma in situ - with

specified treatment;

– non-malignant pituitary adenoma with

specified treatment; or

– removal of one or more lobe(s) of the

lung - for disease and trauma;

in which case the childcover benefit will

be the lower of 12.5 percent of the benefit

and £12,500.

The childcover benefit will be payable once

per child. The maximum benefit payable is

the lower of 50 percent of the benefit and

£25,000, regardless of the number of

memberships held by you.

We will only pay childcover benefit where

the child is under 18 years of age, or under 21

years of age if not in full time employment,

when the child suffers or undergoes a

critical illness, any of the conditions listed in

the ‘What you are covered for’ childcover

benefit section and children’s intensive care

benefit.

We will only pay childcover benefit where

the member is either the parent or legal

guardian of the child or if the member is the

spouse, partner or civil partner of the parent

or legal guardian of the child.

36 |


| 37


We will pay the childcover benefit as a lump

sum, with the lump sum calculated by

reference to the benefit.

Child funeral benefit

We will pay £5,000 towards the cost of a

funeral, if during the period of the agreement,

a child dies, subject to you complying with

the requirements and obligations set out in

the ‘How to make a claim’ section, unless

your claim is excluded by any of the


covered for’ section.

Child funeral benefit is payable in addition

to childcover benefit.

The child funeral benefit payable is £5,000.

The benefit is payable once per child,


held by you. We will only pay child funeral

benefit where the member is either the

parent or legal guardian of the child or if the

member is the spouse, partner or civil partner

of the parent or legal guardian of the child.

We will pay the child funeral benefit as a

lump sum.

Family income benefit

We will pay the benefit to you as an annual

income where the benefit is a family income

benefit, subject to you complying with the

requirements and obligations set out in

the ‘How to make a claim’ section, unless

your claim is excluded by any of the


covered for’ section. We will pay the benefit

annually on each anniversary of the payment

until the last anniversary before the expiry

date set out in your registration certificate.

If you select the indexation option your

benefit will stop increasing once we pay

your claim.

If your registration certificate shows that

you have family income benefit, the benefit

figure that will be used for the lump sum

calculation for these benefits will be the

annual benefit as per the following

calculations:

The annual benefit as shown on your

registration certificate x the remaining

number of years of your membership x 12.5

percent, up to a maximum of £12,500, for the

following benefits:

• carcinoma in situ of the cervix requiring

hysterectomy;

• carcinoma in situ of the urinary bladder;

• cerebral aneurysm - with surgical repair;

• cerebral arteriovenous malformation

- with surgical repair;

• Crohn’s disease treated with surgical

intestinal resection;

• ductal carcinoma in situ of the breast-

with specified treatment;

• non-malignant pituitary adenoma - with

specified treatment;

• removal of one or more lobe(s) of the lung

– for disease and trauma.

38 |


Each of these benefits is defined in the

‘What you are covered for’ section of this

handbook.



number of years of your membership x 25


following benefits:

• low-grade prostate cancer

• coronary angioplasty

• acceleration payment benefit for specified

surgical treatments

• significant visual loss.

Each of these benefits is defined in the ‘What

you are covered for’ section of this handbook.



number of years of your membership x 50


following benefits:

• childcover benefit.

This benefit is defined in the ‘What you are

covered for’ section of this handbook.

What you are not covered for

| 39

What you are not covered forWe will not pay the benefit, childcover

benefit, fracture cover benefit, premium

waiver benefit or any of the benefits set out

in section ‘What you are covered for’ in any of

the following circumstances:

• where your claim is excluded by any

special condition

• where your claim, other than a claim for

the death or terminal illness benefit of a

member, in whole or part, results directly

or indirectly from a self inflicted injury

• where your claim is for critical illness,

unless the member survives for 14 days

after undergoing that critical illness or

being diagnosed with that critical illness

(unless the benefit is claimed under a

critical illness with life cover membership)

• failure to disclose a fact, giving false

information or failing to tell us of a change

in your health or circumstances in relation

to any question in your application before

cover starts where done deliberately or

recklessly gives us the right to cancel

from the start any membership issued as

a result and may invalidate any future

claim. However, where that information

was given carelessly or the failure to

disclose relevant information was

careless, then we will amend the terms of

your membership to be consistent with

what the terms should have been based

on the correct information, unless we

would not have offered any terms for the

membership applied for, in which case

we have the right to cancel the

membership from the start and return

any premiums.

• we will not pay any claim in relation to a

member:

– if it relates to any operation, or intended

operation, unless it was, or is, medically

necessary and was performed by a

consultant in a hospital in which such

operations are routinely carried out.

Additional terms apply to fracture cover

benefit and the premium waiver benefit and

are found in the ‘Additional options’ section.

We will not pay childcover benefit in the

additional following circumstances:

• if symptoms first arose, the underlying

condition was first diagnosed or either

parent received counselling or medical

advice in relation to the condition before:

– the commencement date– your legal adoption or legal

guardianship of the child

• if the condition is brought about by

intentional harm inflicted on the eligible

child by you

• if the child is over 18 years of age and in

full time employment, or over the age of

21 when the child suffers or undergoes; a

critical illness; any of the conditions

listed in the ‘what you are covered for’

childcover benefit section; and children’s

intensive care benefit.


40 |

| 41


• if the child suffers a total permanent

disability

• if the child dies before 14 days after

undergoing a critical illness or being

diagnosed with a critical illness

We will not pay child funeral benefit in the

following circumstances:

• if the child dies before reaching 30 days

old

• if the cause of death first arose before:

– the commencement date

– your legal adoption or legal

guardianship of the child

• if the death is brought about by intentional

harm inflicted on the eligible child by you.

Changes to your membership

42 |

| 43


Changes to your membershipThere are various changes that can be made

to your membership by you and by us.

Changes we can make

If you have ‘Renewable term’ cover, you need

to renew your membership on each

renewal date. Renewal is subject to our

entitlement to change the terms and

conditions of your membership and/or your

cover (including your premiums).

At least 60 days before each renewal date,

we will write to tell you either about any

changes we will make to the terms and

conditions of your membership or your

cover on renewal or if we intend to end your

membership.

If we do not end your membership and you

continue to pay your premiums, your

membership will automatically be renewed

and any changes to your membership will

come into effect upon renewal.

Changes you can make

At any time you may write and ask us to

change the terms of your membership, we

will consider your request at our discretion.

If you ask us to increase the benefit you

have, we can ask you to give us extra

medical, financial or other information to

allow us to consider your application.

If we accept your application, we will

provide the increase either:

• under a new membership governed by the

terms and conditions we apply at the

time; or

• as an increase to the benefit under your membership.

Any increase in the benefit will increase your

premiums.

You may want to increase the benefit you

have when the member, or either member if

more than one:

• gets married or becomes a civil partner

• gets divorced or separated

• obtains a dissolution of a civil partnership

• has a child or adopts a child or becomes

the legal guardian of a child

• takes out a larger mortgage due to

moving house or undertaking home

improvements

• is promoted by their current employer or

starts a new job with a different employer

and their salary increases.

44 |


In these circumstances, we will provide the

increase to you without asking the member

to provide extra medical evidence subject to

all of the following:

• you write to us asking for the increase

within six months of the event, supplying

written evidence to us to show that the

particular circumstance has happened

eg. a marriage certificate or mortgage

loan offer

• the maximum increase in the benefit for

each of the above is the lower of 25

percent of the benefit on the

commencement date and £50,000 or if

the member has family income benefit cover the lower of 25 percent of the

annual benefit and £8,000 per annum

• the total of all increases in the benefit under this option is not more than the

lower of 100 percent of the benefit on the

commencement date and £125,000

• for family income benefit, the total

increases will not exceed £125,000 as

calculated by the annual benefit multiplied by the remaining term under

this membership

• if you want to increase the benefit due to

a mortgage loan, increase must be due to

the member either moving home or

undertaking home improvements

• if you want to increase the benefit because a member’s salary has

increased, the percentage increase is not

more than the percentage increase in

their salary

• we still offer this type of membership at

the time you ask for the increase in benefit

• the member (or eldest member, if more

than one) is under 55 years of age at the

time we receive your request for an

increase

• when we accepted your initial application

for cover we did not apply premiums

above one and a half times our standard

rates at that time or apply any special conditions to your membership

• the increase in the benefit is provided

under a new membership governed by the

terms and conditions (excluding any

option to increase the benefit) that we apply when you ask for the increase or, at our option, as an increase in the benefit under your membership

• the amount by which your premiums will

rise for any increase, is more than the

minimum premium for this type of membership at the time you ask for the

increase

• you may only increase the benefit once

for each of the reasons set out above

• any increase due to a change made is

based on the original benefit on the

commencement of the original membership

• no changes to the membership will be

made or will be effective in the event that

a critical illness has already arisen.

| 45


Any increase in benefit will increase your

premiums. Your premiums will increase by

the cost of providing the extra benefit, based

on the member’s age and our premium rates

at the time of the increase in benefit.

Changes applicable for key person/shareholder protection only

Where you have taken out the membership

as a business on a person working in your

business (a “key person”) or as protection for

your interest in a business (“shareholder/

partnership cover”) or if you are a sole trader,

you may wish to increase the benefit you

have to reflect changes in your business or

the levels of cover you need.

We will allow you to increase the cover you

have without providing extra medical

information where one of the events set out

below occurs and the reason you took out

the cover was one which applies for that

event. We will only allow this subject to the

applicable conditions which are set out in this

section.

In all cases the following conditions must be

met:

• you write to us asking for the increase

within three months of the event,

supplying written evidence to us to show

that the particular circumstance has

happened

• the member is under 55 years of age at

the time we receive your request for an

increase

• when we accepted the initial application

for cover we did not apply premiums

above one and a half times our standard

rates at that time or add any special conditions to your membership

• the increase in the benefit is provided

under a new membership governed by the

terms and conditions (excluding any

option to increase the benefit) that we apply when you ask for the increase or, at our option, as an increase in the benefit under your membership

• the amount by which your premiums will

rise for any increase is more than the

minimum premium for this type of membership at the time you ask for the

increase

• we still offer this type of membership at

the time you ask for the increase in benefit

• the membership was taken out for one of

the reasons specified as applying for the

event in which you are seeking to exercise

the option

• only one increase will be allowed for the membership.

The events on which this option may be

exercised together with the reasons for

taking out the membership which must

apply are as follows:

46 |


• the member is employed by you and their

salary has increased – the reason for

taking out cover for this event must have

been to protect you against losses you

would suffer to your business or the costs

your business would incur if the member

could not continue in their employment

(“key person cover”)

• a business loan you have is increased

– the reason for taking out cover for this

event must have been to provide security

for the loan and have been a requirement

of the lender in making the loan, but

excludes applications from sole traders on

their own lives (“loan cover”)

• the value of your interest in a business you own has increased – the reason for

taking out cover for this event must have

been to provide funds to purchase your interest in the business which has

increased in value (“shareholder/

partnership cover”)

• where you are a sole trader and either your net relevant earnings have increased

or a business loan you have is increased

– the reason for taking out cover for this

event must have been to provide funds for your dependants to replace the earnings

from your trade or to provide security for

the business loan and have been a

requirement of the lender in making the

loan (“sole trader cover”).

The following conditions must be met for

increases in relation to the different types of

cover:

Key person cover

• the maximum increase in the benefit is

the lower of 50 percent of the benefit on

the commencement date and £250,000

• the increase does not exceed five times

the increase in salary to which the request

relates

• any request for an increase greater than

£150,000 is subject to the member making a true declaration that they are in

good health and our agreement that the

financial evidence supports the request

for the increase

• you cannot extend the term of your membership.

Loan cover or shareholder/partnership cover





| 47


Sole trader cover




• if you want to increase the benefit because your net relevant earnings have

increased the increase does not exceed

five times the increase in net relevant

earnings

• any request for an increase greater than

£150,000 is subject to the member making a health declaration and our agreement that the financial evidence

supports the request for the increase


Any increase in benefit will increase your

premiums. Your premiums will increase

based on the cost of providing the extra

benefit, based on the member’s age and

our premium rates at the time of the increase

in benefit.

Premium options

48 |

| 49

Premium options

Premium options

Paying your premiums

You must pay your premiums in advance

throughout your membership (except whilst

you are receiving the premium waiver

benefit). The amount you must pay, and how

often, are shown on your registration

certificate and any endorsements to it.

If you cannot pay your premiums, contact us

immediately.

Changing premiums

This section explains how your premiums

may change (except for yearly increases if

we have provided an indexation option – see

the ‘Additional options’ section).

Whenever we change your premium we will

write to tell you about this at least 60 days

before the date the changes take effect.

We may increase your premium if there is a

change in law, regulatory requirements or

taxation and it is reasonable for us to

increase your premium as a result. In these

circumstances, the increase in your

premiums will be limited to the amount

necessary to cover the increase in cost to us

of providing cover.

Your membership is subject to the payment

of a monthly plan fee, which we collect as

part of your premium. If you have more than

one Friends Life flexible financial protection

membership we will only charge you a plan

fee with your premiums on one membership.

If any other Friends Life flexible financial

protection membership you have ends (for

any reason) we have the right to increase the

premium on your membership. We will only

increase the premium by the amount of any

plan fee forming part of the premium of the

membership which has ended.

Your registration certificate will show

whether your premium option is ‘guaranteed’,

‘reviewable’ or ‘renewable’. The effect of

these different options is explained below.

Guaranteed premiums

• if your premium option is guaranteed, your premium will remain the same for the

term of the membership unless:

– changes in law, regulatory

requirements or taxation mean that it is

reasonable for us to increase the cost

of your cover as a result

– premium increases if the benefit is

increased, for example, if an indexation

option is selected.

50 |

Premium options

Reviewable premiums

• if your premium option is reviewable, we may increase or decrease your premiums

on the fifth anniversary of the

commencement date and at the end of

every following five year period

• when we decide what premiums we charge under this option, we make

assumptions about the future level of

inflation, claim costs, expenses,

investment returns, taxes and levies. When

we review your premiums under this

option, we consider if the combined effect

of these factors is better or worse than

we had assumed and if, as a result, the

cost of the benefit needs to account for

this. We may, as a result, increase or

reduce your premiums by the amount we reasonably believe is necessary

• we may also increase your premiums

under this premium option if there is a

change in law, regulatory requirements or

taxation and it is reasonable for us to

increase your premium as a result

• we will write to tell you about any change

to your premiums at least 60 days

beforehand

• as a result of our review, if your premium

needs to increase, you can tell us to keep

the premium the same and reduce the

amount of benefit instead. Alternatively, you can cancel the membership and

stop paying premiums altogether.

Renewable premiums

• if your premium option is renewable your premiums may increase or decrease at

each renewal without the need for further

medical evidence based on the age of the

member and our premium rates at that

time. Your premiums will almost certainly

increase on each renewal date because

of an increase in age of the member

• renewable premiums are only available

with renewable term

• we will write to tell you about any change

to your premiums at least 60 days

beforehand

• if your premium needs to increase, you can tell us to keep the premium the same

and reduce the amount of benefit instead.

Alternatively, you can cancel the membership and stop paying premiums

altogether

• we may also increase your renewable

premium on the renewal date as set out

above and if there is any change in law,

regulatory requirements or taxation and it

is reasonable for us to do so.

How to make a claim

| 51

How to make a claimIf you wish to make a claim in relation to

your membership, please contact:

Friends Life Individual Protection – Claims

department

PO Box 569

Friends Life Centre

Bristol

BS34 9FE

Or telephone us on 0845 600 3122*

*Calls may be recorded and may be monitored

You must make your claim as soon as you

reasonably can.

When initially notifying us of a claim, you

must provide the following information:

• details of the person(s) dealing with the

claim, their name(s), address, and

telephone number. In some instances this

may be a third party eg. solicitor, next of

kin or executor

• the nature of the illness, disability,

operation or cause of death

• details of the member’s total permanent

disability; or

• details of the member suffering a

fracture; or

• details of any illness or injury the member or child suffers; or

• evidence of a member’s death and

details of the diagnosis of a terminal

illness; or

• evidence of a child’s death

• relevant dates, eg. the date the illness was

diagnosed or date of death

• the registration number under which you are making a claim, this can be found on

the registration certificate. However if

you cannot locate this, we will be able to

assist but will need to know:

– the name of the member, their date of

birth and their address.

Once we have all this information, we will be

able to confirm that a claim can be submitted

to us to consider and we will then forward a

claim form, reply paid envelope and a short

aid detailing the next steps required for the

claim to be assessed.

You must return the claim form to us giving

us any written information or proof we

reasonably require to establish your claim.

We will need evidence, where appropriate of:

• a diagnosis by a medical practitioner

whose specialism is appropriate to the

cause of the claim, where this is necessary

it is explained in the definition of the

particular critical illness;

• a medical report and other information

about the member’s medical condition

and medical history; or

• the results of any independent medical

assessment which we may ask the

member to undergo at our expense.

52 |

How to make a claim

In order to establish that a member has a

critical illness, terminal illness, total

permanent disability, illness or injury, we may

require that the member or child undergoes

a medical assessment. We will pay for the

cost of this assessment.

Where we receive a claim from a member

who is resident outside the UK, we may ask

the member to attend a Friends Life

Individual Protection approved hospital for

medical assessment. In the event that we

cannot obtain the medical information we

require to assess the claim, we also reserve

the right to request that they attend a Friends

Life Individual Protection approved

hospital in a different country or they return

to the UK for the medical assessment. We will

not pay for the member to travel to the UK or

any other country for the medical assessment

but will meet the costs of the medical

assessment itself.

We may also require evidence that you are

entitled to the benefit. For example, in the

event of a death of the sole trustee of the

policy we may need evidence of the

appointment of personal representatives (or

an executor) who will become the new

trustee.

Once we reasonably consider that we have

enough information or proof to establish your

claim, we will pay the benefit, childcover

benefit, fracture cover benefit, premium

waiver benefit or benefits as set out in ‘What

you are covered for’ section, to you as

applicable.

When you make your claim neither you nor

a member must mislead us by either giving

us any false information or keeping relevant

information from us. If either you or a

member does, we will end your

membership and no benefit or childcover

benefit will be paid.

Replacement cover

If your membership covers more than one

member when we have paid the benefit to

you for one member, or one member has

died (without any benefit coming due), you

may take out a new membership covering

the other member, provided that:

• you tell us that you want to take out the

new membership within three months of

the date we paid the benefit to you

• your membership could have continued

for at least five years after the

commencement date of the new membership

• the member to be covered by the new membership must be under 50 years of

age

• the amount of benefit to be provided by

the new membership is not more than the benefit under your original membership

• the new membership will not continue

beyond the date your original membership would have ended

• the total permanent disability option can

only be included in the new membership if

it was included in your original membership

| 53

How to make a claim

• we accepted your initial application for

cover without increasing the premiums

above our standard rates at that time or

applying any special conditions to your

membership

• the new membership is provided under

the terms and conditions we apply at the

time the new membership is taken out

(excluding any option to increase the

benefit).

For information on replacement cover, please

contact us at:


PO Box 569

Friends Life Centre

Bristol

BS34 9FE

Or telephone us on 0845 600 3122*

* Calls may be recorded and may be monitored

54 |

How to make a claim

Your right to cancellation

| 55

Your right to cancellationYou have the right to cancel the

membership and have any premiums paid

refunded if you cancel within 30 days from

the date you receive your registration

certificate and this handbook.

Confirmation of your request to cancel

should be in writing sent by post to the

contact details below. Please note that if

there are two schemeholders, we will require

both schemeholders’ signatures on any

cancellation correspondence.

Once we have been notified of your request

to cancel (within the 30 days period) we

will refund any premiums that you have paid

to us.

If you wish to cancel your membership at

any other time, please write to us at the

address shown below.


PO Box 569

Friends Life Centre

Bristol

BS34 9FE

Tel: 0845 600 3122*

We will write to you to confirm the

cancellation of your membership.

Please note that outside of the initial 30 day

cancellation period:

• no refund of premiums will be due unless you have paid an annual premium and

you cancel your cover before the next

premium is due, in which case, provided

no claim has been made, we will give you

a pro-rata refund but we will deduct the

discount you would have received in that

year for paying an annual premium, or you

cancel your membership in accordance

with with the section headed ‘Changes to

these terms and conditions’.

Please note that Friends Life Individual

Protection contracts have no surrender value.

56 |

Your right to cancellation

* Calls may be recorded and may be monitored

General information

| 57

General information

Changes to your registration certificate

If we need to change any details on your

registration certificate, or add new details

to it, we will send you a new registration

certificate or an endorsement, providing

the most up to date details of your

membership and will replace any earlier

registration certificate (including any

endorsements on it). Your registration

certificate will show the date on which it

replaced the earlier registration certificate.

Assigning and surrendering your membership

Your membership has no surrender value.

You will not receive any benefit or refund of

premiums when your membership ends.

If you assign your membership, you or the

assignee should provide us with written

notification of this.

Changes to these terms and conditions

a) We reserve the right from time to time by

giving you 60 days notice, so far as it is

practicable to do so, to make such changes

or additions to this membership handbook

as may reasonably be required:

• to reflect any change of law, regulatory

requirement or taxation; or

• because of circumstances outside of our control, which we could not reasonably

have forseen, which either significantly

add to the costs of providing any benefit

or of administering the policy, or which

would make it impractical to provide any

benefit or administer the policy;

• to allow us to provide benefits or

administer your policy more efficiently;

• to change anything which is unclear or

incorrect.

b) We reserve the right, from time to time, to

make changes or additions to this

membership handbook for any

administrative or other reason, which may or

may not have a detrimental effect on you

and which are not set out in a) above. If you

suffer a material detriment as a result of a

change or addition to this membership

handbook under this paragraph b), you may

notify us and you will be free to cancel your

policy. In that case, we will give you a

pro-rata refund of any premium you have

already paid for the period following the date

of cancellation, unless a claim has already

been made under your policy.


Only we can make any changes to your

membership (in accordance with our rights

under your membership), confirm any

changes you have asked for or decide not to

enforce any of our rights. Any change to your

membership will come into force only when

confirmed by us in writing.

58 |

General information

| 59

General information

If we ever decide not to enforce our legal

rights, this does not prevent us from

enforcing those rights in the future.

Written communication

We will send any letters to you to the

address you last gave us. If you change

address you must always write and tell us.

If you write to us, you must send that

letter to:


PO Box 569

Friends Life Centre

Bristol

BS34 9FE

If we change this address we will write to

you with details of where you should write

to us.

You and we can assume that a letter has

been received:

• three days after it was sent by first class

post.

Choice of law

Friends Life and you have a free choice

about the law that can apply to a contract.

Friends Life proposes to choose the law of

England and Wales and by entering into this

contract you agree that the law of England

and Wales applies.

Jurisdiction

The Courts of England and Wales have

non-exclusive jurisdiction over any claim,

dispute or difference which may arise out of,

or in connection with, the terms and

conditions of this membership handbook.

Getting in touch

60 |

Getting in touchOur helpline is always the first number to call

if you need help or support or if you have any

comments or complaints. Please call us on

0845 600 3122*.

*Calls may be recorded and may be monitored

Alternatively, you can write to us at:


PO Box 569

Friends Life Centre

Bristol

BS34 9FE

Making a complaint

If you have not been able to resolve a

problem and you wish to take your

complaint further, please write to Customer

Relations at the address above.

It is rare that we cannot settle a complaint,

but if this does happen, you may refer your

complaint to the Financial Ombudsman

Service. You can write to them at:

South Quay Plaza

183 Marsh Wall

London

E14 9SR

www.financial-ombudsman.org.uk

Or call them on their consumer helpline on

0800 023 4567 (calls to this number are

normally free for people ringing from a ‘fixed

line’ phone - but charges may apply if you

call from a mobile phone) or 0300 123 9123

(calls to this number are charged at the

same rate as 01 or 02 numbers on mobile

phone tariffs).

Please let us know if you want a full copy of

our complaints procedure.

If something has gone wrong, we want to do

everything we can to put it right. But none of

these procedures affect your legal rights.

The Financial Services Compensation Scheme (FSCS)

In the unlikely event that we cannot meet

our financial obligations, you may be entitled

to compensation from the Financial Services

Compensation Scheme. This will depend on

the type of business and the circumstances

of your claim. The FSCS may arrange to

transfer your membership to another

insurer, provide a new policy or, where

appropriate, provide compensation.

Further information about compensation

scheme arrangements is available from the

FSCS on 020 7741 4100 or on its website

www.fscs.org.uk

| 61

Getting in touch

Friends Life and Pensions LimitedAn incorporated company limited by shares and registered in England and Wales, number 475201.Registered office: Pixham End, Dorking, Surrey RH4 1QA. Authorised by the Prudential RegulationAuthority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.

Telephone 0845 600 3122 – calls may be recorded. www.friendslife.co.ukFriends Life is a registered trade mark of the Friends Life group.FL

IP/4

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May

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392

UN

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For more information, please contact us on:

0845 600 3122†

Friends Life Individual Protection, PO Box 569 Friends Life Centre, Bristol, BS34 9FE

†Calls may be recorded and may be monitored

This document is available in other formats.If you would like a Braille, large print or audio version of this document, please contact us.

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